Journal of Dental Implants
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January-June 2020
Volume 10 | Issue 1
Page Nos. 1-49

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EDITORIAL  

Dental Implant Practice in the Post COVID-19 Era: Wading the Realities p. 1
Sharat Shetty
DOI:10.4103/jdi.jdi_15_20  
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ORIGINAL ARTICLES Top

Comparative clinical evaluation of esthetic parameters of immediately provisionalized implants in the esthetic zone with their natural counterparts p. 3
Vrushika Mahajan, Rajesh Kshirsagar, Vikram Singh, Sudhir Pawar
DOI:10.4103/jdi.jdi_18_19  
Background: An anterior single implant-supported crown restoration in the maxillary anterior region must meet a particularly high standard of esthetic quality. The standard of care for edentulous space in esthetic zone therefore would be the placement of an implant with immediate provisionalization. Aims and Objecectives: The aim of this study is to evaluate the esthetic parameters of immediately provisionalized implants in the esthetic zone and compare patients opinion with blinded clinicians opinion of the outcome of esthetics of implant in esthtic zone. Materials and Methods: In our study, we placed 10 maxillary anterior single-tooth implants in fully healed maxillary anterior sites in esthetic zone. All the implants were provisionalized within 24 hours. Zirconia prosthesis was delivered as definitive prosthesis after three months of implant placement. The esthetic zone was photographed three months after delivering the definitive prosthesis. The esthetic outcome was then evaluated objectively using Pink Esthetic Score (PES) and White Esthetic Score (WES) by a blinded clinician. In addition, we used a triple score technique Visual Analogue Scale(VAS) wherein the patients commented on the soft tissue, prosthetic as well as the overall esthetic outcome. Results: A mean PES of 9.2± 1.03 and a mean WES of 8.7± 1.16 recorded showed an acceptable peri-implant soft tissue outcome and an acceptable prosthetic outcome respectively. The statistical analysis revealed statistically significant correlation between patients' esthetic perception and dentists' perception of the anterior tooth. Conclusion: The PES/WES is an objective tool in rating the esthetics of implant supported single crowns and adjacent soft tissues. Orthodontists were the most critical observers, while periodontists were more generous than other observers. The statistical analysis revealed a statistically significant correlation between patients' esthetic perception and dentists' perception of the anterior tooth.
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Evaluation of two different attachment systems used with mandibular implant-retained overdenture p. 10
Mohamed Yousef Abdelfattah, Mohamed Khalil Fahmi
DOI:10.4103/jdi.jdi_23_18  
Objectives: The aim of this study was to evaluate the effect of two different attachment systems on the retention and implant stability of implant-retained mandibular overdenture. Materials and Methods: Fourteen completely edentulous patients with age ranged from 47 to 65 years planned to receive conventional complete denture. Following the treatment protocol, each patient received two implants in the mandibular anterior region, and after insurance of the osseointegration, the patients were randomly divided into two groups – Group A received Ball/O-Ring attachment and Group B received locator attachment. The retention of two groups was assessed by the digital force meter at three times (T): T0 – retention of conventional complete denture, T1 – at time of insertion of implant-retained mandibular overdenture, and T3 – retention after 3 months of insertion of implant-retained mandibular overdenture. The implant stability quotient (ISQ) was done using Magnetic Resonance Frequency Analyzer (Osstell, ISQ) at the time of loading then after 3 and 6 months. Results: The retention values before the insertion of overdenture (T0) were considerably low in comparison with those at time of insertion of overdenture (T1) and after 3 months from denture insertion (T3). Regarding the ISQ values, there was no significant difference between the two groups before and at the time of insertion of implant while there was a significant difference between the two groups with better stability results in the locator attachment group after 3 months (P < 0.05). Conclusion: Within the limitation of this study, both types of attachment systems, i.e., Ball/O-Ring and locator attachments are reliable modalities for improving the retention and stability of implant-retained mandibular overdenture with superior initial stability results for the locator attachment.
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A comparative evaluation of changes in microbial flora in delayed and immediate placed implants: An in vivo study p. 16
Keerthi G Hiremath, Viraj N Patil, Zarir Ruttonji, Preethi Kusugal, KM Sushma, Preeti Astagi
DOI:10.4103/jdi.jdi_19_19  
Background: Dental implants provide a unique opportunity for the observation of initial bacterial colonization and also for the estimation of time needed for the establishment of complex microflora. While many factors are important in determining the long-term success or failure of dental implants, very little is known about the relative importance of the subgingival bacterial populations around implants. Aim: The aim of the study was to estimate peri-implant microbial colonization in patients with immediate and delayed implants and the differences in peri-implant microflora between immediate and delayed implants. Materials and Methods: In the current study, the organisms found in the oral cavity prior to placing the implants and during the various stages of implant treatment in both the categories were assessed. Results: In the current study, organisms such as Streptococci are consistently seen. The presence of organisms such as Porphyromonas gingivalis and Fusobacterium, which have pathogenic potential, is of importance. Conclusion: In this study, the following conclusions were made; the mode of implant placement either immediate or delayed does not alter the peri-implant microflora. Organisms present preoperatively were consistently present during the entire phase of the treatment. This study suggests that regular microbial evaluation along with clinical and radiographic monitoring could help in recognizing the potential for peri-implantitis and in the prevention of the same for better prognosis.
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An in vitro evaluation of microleakage in platform-switched implants at implant–abutment interface by contamination assessment of implant wells and respective abutment surfaces p. 22
V Yamuna, Roseline Meshramkar, RD Kulkarni, Manjunath A Hosamani, K Lekha, Ramesh K Nadiger, Nagarajan Chidambaram
DOI:10.4103/jdi.jdi_12_19  
Background and Objectives: In contemporary implant dentistry, the success of implant treatment is assessed by measuring the crestal bone level apart from osseointegration. Peri-implant bone plays a vital role in the esthetics of implant restorations. With loss of peri-implant bone, soft tissue loss happens which eventually compromises the esthetics and mechanical properties of restorations. To prevent marginal bone loss, many inventions are made by modifying the implant designs, implant–abutment connections, and techniques. Platform-switched concept is one such invention evolved to prevent peri-implant bone loss. This beneficial effect of platform-switched implants was studied by many researchers. However, few studies were reported in the literature on microleakage in platform-switched implants. Thus, the purpose of this study is to evaluate microleakage at implant–abutment interface in platform-switched implants. Materials and Methods: Fifteen in-built platform-switched implants and corresponding abutments with internal hexagonal design were connected using screws. After the confirmation of the sterility of the implants and abutments, the assemblies were incubated in brain–heart infusion broth inoculated with Staphylococcus aureus for 14 days at 37°C. After 14 days, the implants and abutments were disassembled. Samples were collected from three different sites, i.e., walls of the wells of the implants, the deepest portion of the wells of the implants, and the surface of the abutments with help of paper points. Using the samples, colony counting and Gram staining were done to evaluate the microleakage at the implant–abutment interface. Results: Microbial contamination was found to be present at all the sites from which samples were collected.P < 0.05 was found when the different sites were compared with each other. The abutment surface found to have the least contamination, and the walls of the implant wells found to have the highest contamination. Conclusion: Within the limitations of this study, it was concluded that microleakage is present in the platform-switched implants with screw-retained internal hexagonal connections at the implant–abutment interface.
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Design and analysis of tooth abutment implant p. 35
Shailja Awasthi, Vinay Pratap Singh
DOI:10.4103/jdi.jdi_8_19  
In human being, tooth loss is a common problem which may be due to various disease and trauma. Dental implants are used to provide support for the replacement of missing teeth. Research on dental implant designs, materials, and techniques is continuously increasing. There is still a lot of work involved in the use of better biomaterials, implant design, surface modification, and functionalization of surfaces to improve the long-term benefits of implant treatment. This paper provides a brief history of dental implants and its parts. This describes the new designs and conventional design of tooth abutment implant and stress distribution using finite element analysis method on the surface of the whole system under various loading conditions. It describes the suitable materials and its properties which can be used for making tooth abutment implant. This also describes how to remove complexities which is associated with tooth abutment implants such as its motion, complex design of screw, and high cost. Background: The attempts to overcome the problem of tooth loss and to find out a way of replacing missing teeth date back to as old as the history of human beings. Many materials, many geometric forms, surgical and prosthetic methods have been tried till now for the dental implants. Scarcely existing archeological reports demonstrate the attempts of different prosthetic devices used as natural and functional replacements. It is found that transplantation procedures and devices are used by Egyptians, Greeks, Romans, Chinese, Indians and Arabs. Furthermore naive artificial units such as shaped stone, wood, cast iron and carved sea shells, bone and natural teeth taken from various animals and even teeth sold by the poor or slaves have been tried as implantation material. A tooth shaped piece of shell is found by an archeologists which is placed into the socket of missing teeth of a women in 1931. Later, in 1970, a Brazilian dental academic, Amadeo Bobbio, investigated that mandibular specimen and in the radiographs he took, he observed bone formation around the implant-like structures. In 18th century, humans donated their teeth in exchange for some fee but human's body precluded the adaptation of foreign materials. Le Mayeur implanted one hundred and seventy donated teeth in 1785 and 1786 but he was not able to get successful results. In 19th century, predicating on a false assumption that precious materials would be well tolerated by biological tissues, gold, silver, platinum and some other metal alloys were used as implant materials, which resulted in extremely poor long-term results. The human's body reject these type of material basically because they were not inert. Venable et al. (1937) found that the metals that are not inert they tend to ionize when they come into contact with body resulting in producing metallic salts causing excessive proliferation of some tissues whereas inhibiting bone formation. The prevention of bone formation around the implant leads to failure of the implantation. The modern breakthroughs in dental implantology emerged as a result of so-called serendipity of a Swedish orthopedic surgeon, Dr. Branemark, in 1952. While studying bone healing and regeneration around 'the rabbit ear chamber', which was a chamber of titanium designed and developed as a part of research conducted in Cambridge University, he observed in microscopic level that bone had grown around titanium surface in so close proximity that he was unable remove the chamber form the rabbit femur. Dr. Branemark investigated this phenomenon through further studies on animal and volunteer human tissues, which all contributed to unveiling the biocompatible properties of titanium. Having initially been considered to be appropriate for applications in the field of orthopedics such as knee or hip surgery, later titanium is realized to be utilized as anchorage for dental prosthesis and artificial crowns. The first titanium implant was inserted into the jawbone of a human volunteer, Gosta Larsson, for providing an artificial root for prosthetic teeth. Also, in 1967, Leonard Linkow presented his blade-form titanium implants providing mechanical stability and function for partial and complete dentures. In 1970 to 1980 many experimental studies were carried out to obtain better designs and geometric forms for titanium dental implants some of which are the IMZ Implants, TPS Implants, ITI Hollow-Cylinder Implants. Throughout this period, Dr. Branemark continued his research and in 1971 he introduced titanium hollow screw implants which resulted in increased success rate, clinical applicability and reduced rate of complications compared to blade-form implants. In 1978, he established a commercial partnership with a Swedish defense company, Bofors AB. In 1981, based on the partnership, Nobel Biocare, one of the largest current dental implant producers in the world, was founded with the aim of focusing directly on dental implantology. In the year 1982, the Toronto Conference on osseointegration in Clinical Dentistry set the first guidelines for successful implant dentistry. The successful integration of hollow screw geometry into bone and high biocompatible characteristics of titanium resulted in that screw form dental implants have become the preferred method of tooth replacement and a standard dental treatment technique. Providing a high rate of success and a wide range of restorative options, today, dental implants, under various brand names, are extensively used worldwide. Current studies are mainly focused on improving aesthetics, reducing healing period and simplifying the use of dental implants. Objectives: Based on the previous work it was observed that the current dental implant suffers from several shortcomings. In order to minimize these shortcomings several objectives are as follows-. 1. Make a novel design of tooth abutment implant without using screw because the manufacturing process of screw of small part is difficult and costly. 2. Model the new improved tooth abutment implant and subject it to working load. 3. Model the implant considering cost minimization of tooth abutment implant. 4. Analyze and validate the results of stress analysis. Materials and Methods: Here Titanium alloy is used for making new designs because it has better biocompatibility, bonding strength, high corrosion resistance and it prevents to fracture. Solidworks software is used for modeling and ANSYS software is used for analysis. Results: Von-Mises stress distribution is calculated under normal load and maximum load on the top surface of the abutment of conventional design and new designs. Conclusions: After comparing the stress distribution of all the new designs with conventional design and ultimate strength of titanium alloy found the best design of tooth abutment implant.
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PRACTITIONER SECTION Top

The effect of two regenerative surgical treatments for peri-implantitis defect using porous titanium granules alone and a combination of bovine bone mineral with collagen membrane: A systematic review p. 45
Mohammed Siddique Qureshi, Nayana Shriram Anasane, Amit Jagtap
DOI:10.4103/jdi.jdi_20_19  
Implant success has broad definitions in clinical practice. Dental implant is becoming a common option for the replacement of lost teeth; there are various reasons for implant failure; one of them is peri-implantitis. This systematic review compares the two regenerative surgical treatment options for peri-implantitis. This systematic review was conducted to compare the effect of porous titanium granules and bovine bone mineral with the collagen membrane as a regenerative surgical treatment for peri-implantitis. A systematic search was performed in the PubMed database, Google Scholar, Institutional Library, and manual search of various journals. Cross-references were checked from relevant articles. Filters were put for the dates of publication from January 2000 to December 2016. Language restriction was put to English only. A total number of 367 articles were identified through the electronic search. Only six articles were included on the basis of inclusion and exclusion criteria. All the six articles were reviewed for the study characteristic. All the articles have shown good results when porous titanium granules and combination bovine bone mineral with collagen material was used to treat peri-implantitis. Porous titanium granules can be used as a regenerative surgical treatment for peri-implantitis; however, bovine bone mineral along with collagen membrane is a better regenerative treatment.
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